INTERELATIONSHIP BETWEEN IDA AND VITAMIN D DEFICIENCY IS NOW ESTABLISHED

Transcription

1 INTERELATIONSHIP BETWEEN IDA AND VITAMIN D DEFICIENCY IS NOW ESTABLISHED

2 Rationale for Combining Iron & Vit-D Vit D deficiency and Iron deficiency Anaemia the two most menacing disorders - are inter-related (interlinked) Deficiency of one leads to deficiency of other

3 Mechanism Vit-D D deficiency causes Anaemia

4 Mechanism Iron deficiency Anaemia causes Vit-D D deficiency

5 Continuous Viscous cycle Supplementation of both Iron and Vit-D would provide optimum benefit.

6 Anaemia Deficiency in the oxygen-carrying capacity of the blood due to a diminished erythrocyte mass. May be due to: Erythrocyte loss (blood loss) Decreased Erythrocyte production Low erythropoietin Decreased marrow response to erythropoietin Increased Erythrocyte destruction (hemolysis)

7 Classification Based on Severity in Pregnancy ICMR WHO Mild gm/dl 9 11 gm/dl Moderate Severe 4 7 <7 Very severe <4

8 Causes of Anemia in Pregnancy Physiological anemia Nutritional anemia IDA, megaloblastic Anemia of chronic illness Blood loss Hemolysis and hemolytic anemias Hemoglobinopathies Other hereditary anemias Aplastic anemia

9 Measurements of Anemia Hemoglobin = grams of hemoglobin per 100 ml of whole blood (g/dl) Hematocrit = percent of a sample of whole blood occupied by intact red blood cells RBC = millions of red blood cells per microl of whole blood MCV = Mean corpuscular volume

10 Morphological Classification By the size of the RBCs Macrocytic anemia (MCV > 100) Normocytic anemia (80 < MCV < 100) Microcytic anemia (MCV < 80)

11 Morphological Classification Size of erythrocytes is larger than normal Megaloblastic anemia Vitamin B12, Folate deficiency. Hb levels decreased MCV normal Acute blood loss Anemia of chronic disease Aplastic anemia Hemolytic anemia Size of erythrocytes is smaller than normal Heme synthesis defect Iron deficiency anemia Anemia of chronic disease Thalassemia

12 Normocytic Anemia Is a condition in which the size & Hb content of RBCs is normal but the number of RBCs is decreased. It includes Aplastic anemia due to BM failure Blood loss anemia Hemolytic anemia 12

13 Microcytic Anemia any RBCs smaller than nucleus of normal lymphocytes ncreased central pallor. ncludes Iron deficiency anemia Thalassemia Anemia of chronic disease Sideroblastic anemia Lead poisoning 13

14 Macrocytic Anemias A. MEGALOBLASTIC ANEMIA Vitamin B12 deficiency Folate deficiency Abnormal metabolism of folate and vit B12. Non megaloblastic anemia Liver disease Alcoholism Post splenoctomy Neonatal macrocytosis Stress erythropoiesis Wright s stained blood smear

15 Clinical Features - Symptoms Moderate anemia - weakness, fatigue, exhaustion, loss of appetite, indigestion, giddiness, breathlessness Severe anemia - palpitations, tachycardia, breathlessness, increased cardiac output, cardiac failure, pulmonary edema

16 Clinical Features - Signs Pallor Nail changes Cheilosis, Glossitis, Stomatitis Edema Hyperdynamic circulation (short & soft systolic murmur) Fine crepitations

17 Iron Requirement in Pregnancy 2.5mg /day in early pregnancy 5.5mg /day from weeks 6 8 mg/ day after 32 weeks Average 4 mg/ day

18 Iron Absorption Step 1 Reduction: Fe 3+ (Du Cyt B/ Ascorbic acid) Fe 2+ Intestinal Lumen Step 2 Absorption : Fe 2+ (DMT 1) Fe 2+ Intestinal Lumen Step 3 Transportation: Fe 2+ (Ferroportin + Hephaestin) Enterocyte Step 4 Transferrin: Blood Step 5 Bone Marrow

19 Iron Absorption

20 New Therapeutic Alternatives The side effects of older Iron preparations & their poor compliance even on providing free tablets are the most important reasons of failure of anaemia control programmes Newer preparations are better tolerated, have less side effects with better compliance Carbonyl Iron Ferrous ascorbate

21 Merits of New Preparations (Ferrous Ascorbate) Outstanding GI Tolerance in contrast to 20% severe side effects with conventional therapy Very safe with no poisoning even in high doses No interaction with food stuffs The newer preparations are delicious with non-metallic taste and don t stain the patients teeth Hence the compliance is very high

22 Indications In Pregnancy Lactation IDA Blood loss during Menstruation

23 USP s Ferrous Ascorbate: High Bioavailability Faster Hb rise High Absorption : Ascorbate component of Ferrous ascorbate inc. the iron absorption by 6 times. Better safety and tolerability compared to conventional salts. Lesser GI irritation, hence better compliance.

24 USP s Vitamin D3 Activates erythroid precursors, helps in the initial phase of Erythropoiesis. Essential for the prevention of hypovitaminosis D in the fetus and deficiency at birth and in early infancy. Increases hemoglobin levels and reticulocyte count in hematological disorders Vitamin B12 + Folic Acid Helps in the production of RBC s